“I am sure parents of children with MS read this blog. This study on paediatric MS below highlights just how heavy the burden of MS is on the immature and developing brain and must scare the hell out of any parent. A third of children had significant problem on a least one of the scales assessed with attention problems, somatisation, and anxiety being the most common. What to about this? I suspect the same principles apply to treating MS in children as they do to treating MS in adults; early effective treatment with a target. Maybe we need to be even more aggressive in paediatric MS? The developing brain seems like it is more susceptible to damage than the mature adult brain.”
“I have just written a commentary for one of the MS journals on flipping the pyramid and my personal reasons for doing it. What this means is simply starting with the highest efficacy treatments first-line. On reflection I should have included a section on paediatric MS. The problem with paediatric MS is that there is very little evidence to guide clinical practice. A very useful study would be to compare the flipping the pyramid strategy to the current standard of care and to see how they do in relation to cognitive and behavioural outcomes. One of the concerns in relation to flipping the pyramid in children is the concern people have about the potential impact of these treatments on the developing immune system; these concerns clearly need to be balanced against the risk of the disease to the child, in particular their brain development. I suspect most parent given the facts would prioritise the brain over the immune system.”
Charvet et al. Behavioral Symptoms in Pediatric Multiple Sclerosis: Relation to Fatigue and Cognitive Impairment. J Child Neurol. 2016 Mar 9. pii: 0883073816636227.
Background: The emotional and behavioral problems associated with pediatric multiple sclerosis remain unclear.